technetium-tc-99m-exametazime and Chronic-Disease

Left-sided hemichorea developed suddenly in a 73-year-old male. Computed tomography revealed a left subdural hematoma (SDH) and infarction in the right corona radiata and temporo-occipital region. Hemichorea subsided completely after removal of the SDH. Postoperative single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime revealed a global low-perfusion area in the right cerebral hemisphere. Right carotid angiography demonstrated severe stenosis of the trunk of the right middle cerebral artery. The cerebral blood flow in the right cerebral hemisphere had probably already decreased to nearly the critical level and was reduced further by the left SDH, inducing the left-sided hemichorea due to dysfunction of the right cerebral hemisphere. This case shows that when hemichorea ipsilateral to a SDH is present, it is important to ascertain whether there is a pre-existing ischemic lesion in the contralateral cerebral hemisphere, particularly in the basal ganglia, thalamus, or corona radiata.

Topics: Aged; Cerebral Infarction; Chorea; Chronic Disease; Dominance, Cerebral; Hematoma, Subdural; Humans; Magnetic Resonance Imaging; Male; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

A great deal of effort has been made to evaluate and define the role of various diagnostic imaging techniques in various clinical settings that complicate the diagnosis of osteomyelitis. Except possibly in neonates, bone scintigraphy remains generally recommended when there has been no previous osseous involvement. In other cases of chronic disease, previous fracture or trauma, prosthesis, and diabetic foot, In-WBC scintigraphy is generally accepted as an appropriate imaging technique. MRI will play an increasingly important role in diagnosing osteomyelitis and may prove to be an important adjunct in these cases. Research continues to improve our current diagnostic armamentarium. In-IgG appears to avoid practical deficiencies encountered with 67Ga and In-WBC; it remains to be seen what role this agent will play in routine clinical practice. All agents to date image inflammation, not infection, and most require delayed imaging sessions, usually at 24 hours. These shortcomings necessitate further research to develop new radiotracers that can provide useful images within several hours and that are specific for infection, perhaps ultimately delineating the particular microorganism involved.

Topics: Adult; Bone Diseases; Child; Chronic Disease; Gallium Radioisotopes; Humans; Immunoglobulin G; Indium Radioisotopes; Infant, Newborn; Infections; Magnetic Resonance Imaging; Muscular Diseases; Organotechnetium Compounds; Oximes; Recurrence; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The diagnosis of osteomyelitis is a challenge for diagnostic imaging. Nuclear medicine procedures including white blood cell imaging have been successfully used for the identification of bone infections. This multinational, phase III clinical study in 22 European centres was undertaken to compare anti-granulocyte imaging using the murine IgG antibody besilesomab (Scintimun) with (99m)Tc-labelled white blood cells in patients with peripheral osteomyelitis.. A total of 119 patients with suspected osteomyelitis of the peripheral skeleton received (99m)Tc-besilesomab and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cells (WBCs) in random order 2-4 days apart. Planar images were acquired at 4 and 24 h after injection. All scintigraphic images were interpreted in an off-site blinded read by three experienced physicians specialized in nuclear medicine, followed by a fourth blinded reader for adjudication. In addition, clinical follow-up information was collected and a final diagnosis was provided by the investigators and an independent truth panel. Safety data including levels of human anti-mouse antibodies (HAMA) and vital signs were recorded.. The agreement in diagnosis across all three readers between Scintimun and (99m)Tc-HMPAO-labelled WBCs was 0.83 (lower limit of the 95% confidence interval 0.8). Using the final diagnosis of the local investigator as a reference, Scintimun had higher sensitivity than (99m)Tc-HMPAO-labelled WBCs (74.8 vs 59.0%) at slightly lower specificity (71.8 vs 79.5%, respectively). All parameters related to patient safety (laboratory data, vital signs) did not provide evidence of an elevated risk associated with the use of Scintimun except for two cases of transient hypotension. HAMA were detected in 16 of 116 patients after scan (13.8%).. Scintimun imaging is accurate, efficacious and safe in the diagnosis of peripheral bone infections and provides comparable information to (99m)Tc-HMPAO-labelled WBCs.

Topics: Adult; Animals; Chronic Disease; Female; Humans; Immunoglobulin G; Inflammation; Leukocytes; Mice; Middle Aged; Osteomyelitis; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Vital Signs

Chronic pain is defined as intractable pain caused by abnormal pain transmission or impairment of the pain control system per se. Alteration of regional cerebral blood flow (rCBF) is known to occur under the presence of pain stimulation. Epidural spinal cord stimulation (SCS) is occasionally effective in relieving the symptom.. The aim of the current study is to investigate the alteration of rCBF in baseline condition and to find the association between the rCBF change and the efficacy of SCS in chronic pain.. A total of 18 patients underwent Tc-99m-HMPAO SPECT before and after SCS. Analysis with three-dimensional stereo-tactic surface projections (3D-SSP) with stereo-tactic extraction estimation (SEE) software was adopted to evaluate the rCBF. We assessed the extent score of the abnormal region in each segment (rate of the coordinates with a Z-value that exceeds three kinds of threshold value 2.0, 2.5 and 3.0 in all coordinates within a segment). According to the therapeutic response defined by visual analogue scale, we categorized patients into two groups, the good responder (GR) group (n=12) and poor responder (PR) group (n=6). In the analysis, we compared the extent score in the following two conditions. (1) Comparison between the PR group and normal control group under both baseline condition and after SCS. (2) Comparison between the GR group and normal control group under both baseline condition and after SCS.. (1) In the PR group, increased rCBF was observed in left thalamus, bilateral precuneus and bilateral cerebellum under the baseline condition. After SCS, the range of these increased rCBF areas localized but remained. Decrease of rCBF was noted in bilateral subcallosal gyrus, superior temporal gyrus (STG) and bilateral anterior cingulate gyrus (ACG). They localized after SCS, but remained. (2) In the GR group, increased rCBF areas were noted in bilateral precuneus and bilateral cerebellum under the baseline condition. After SCS, they localized in bilateral precuneus but those of bilateral cerebellum remained. Decreased rCBF area was noted in bilateral subcallosal gyrus, STG and bilateral ACG under the baseline. After SCS, they localized in bilateral subcallosal gyrus and bilateral STG. In contrast, they enlarged in bilateral ACG.. Chronic pain patients demonstrated abnormal rCBF distribution on both baseline and post SCS conditions. Increased rCBF of thalamus and precuneus under both conditions in the PR group and decreased rCBF of ACG under post SCS conditions in the GR group were characteristic patterns. Tc-99m-HMPAO SPECT with 3D-SSP and SEE analysis is likely objective and effective in monitoring and evaluating therapeutic outcome by SCS in chronic pain. In addition, it provides information that is useful in the selection of SCS candidates.

Topics: Brain; Cerebrovascular Circulation; Chronic Disease; Electric Stimulation Therapy; Epidural Space; Female; Humans; Male; Middle Aged; Pain; Pain Management; Prognosis; Radiopharmaceuticals; Spinal Cord; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

Vagus nerve stimulation (VNS) has gained recognition as a treatment for refractory epilepsies where surgical treatment is not possible. While it appears that this treatment is effective in some patients, the mechanism of action is not clearly understood. The purpose of this study was to clarify findings of other positron emission tomography and single-photon emission tomography (SPET) investigations by measuring the acute effect of VNS on patients who have normal cerebral anatomy on magnetic resonance imaging and who have not previously been exposed to VNS. We investigated six subjects (two males and four females, mean age 29.5 years, range 21-39 years) with intractable epilepsy. One patient had primary generalised epilepsy causing generalised tonic-clonic seizures; the remaining five patients had localisation-related epilepsy causing complex partial seizures. SPET imaging was performed using 250 MBq of (99m)Tc-HMPAO and a four-scan paradigm - two with and two without stimulation. The stimulation began at VNS current levels of 0.25 mA and was increased according to the limit of patients' tolerance, usually defined by coughing or discomfort. The stimulating waveform was of continuous square wave pulses of 500 micro s duration at 30 Hz. Image analysis was by SPM99. Reduced perfusion during stimulation was observed in the ipsilateral brain stem, cingulate, amygdala and hippocampus and contralateral thalamus and cingulate. The study provides further evidence of the involvement of the limbic system in the action of vagal nerve stimulation.

Topics: Adult; Brain; Cerebrovascular Circulation; Chronic Disease; Electric Stimulation Therapy; Epilepsy; Female; Humans; Limbic System; Male; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Vagus Nerve

An increased occurrence of major depressive disorder has been reported in tinnitus patients, and of tinnitus in depressive patients. Involvement of several Brodmann areas (BAs) has been reported in tinnitus perception. The aim of this study was to assess the regional cerebral blood flow (rCBF) changes in depressed patients with and without tinnitus. The rCBF distribution at rest was compared among 45 patients with a lifetime prevalence of major depressive disorder, of whom 27 had severe tinnitus, and 26 normal healthy subjects. 99mTc-hexamethylenepropylene amine oxime (99mTc-HMPAO) single photon emission computed tomography (SPECT), using a three-headed gamma camera, was performed and the uptake in 34 functional sub-volumes of the brain bilaterally was assessed by a computerized brain atlas. Decreased rCBF in right frontal lobe BA 45 (P<0.05), the left parietal lobe BA 39 (P<0.00) and the left visual association cortex BA 18 (P<0.05) was found in tinnitus patients compared with non-tinnitus patients. The proportion of tinnitus patients with pronounced rCBF alterations in one or more of the temporal lobe BAs 41+21+22 was increased compared to gender matched controls (P<0.00) and patients without tinnitus (P<0.05). Positive correlations were found between trait anxiety scales from the Karolinska Scales of Personality and rCBF in tinnitus patients only in three limbic BAs (P<0.01), and inverse correlations in non-tinnitus patients only in five BAs subserving auditory perception and processing (P<0.05). rCBF differences between healthy controls and depressed patients with and without tinnitus were found in this study. The rCBF alterations were distributed in the cortex and were particularly specific in the auditory cortex. These findings suggest that taking audiological symptoms into account may yield more consistent results between rCBF studies of depression.

Topics: Age Factors; Analysis of Variance; Brain; Cerebrovascular Circulation; Chronic Disease; Depressive Disorder; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Radiopharmaceuticals; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Sex Factors; Subtraction Technique; Technetium Tc 99m Exametazime; Tinnitus; Tomography, Emission-Computed, Single-Photon

Early differential diagnosis between Tourette's syndrome and chronic tic disorder is difficult but important because both the outcome and the treatment of these two childhood-onset diseases are distinct. We assessed the sensitivity and specificity of brain single-photon emission tomography (SPET) perfusion imaging in distinguishing the two diseases, and characterized their different cerebral perfusion patterns. Twenty-seven children with Tourette's syndrome and 11 with chronic tic disorder (mean age 9.5 and 8.6 years, respectively) underwent brain SPET with technetium-99m hexamethylpropylene amine oxime (HMPAO). Visual interpretation and semiquantitative analysis of SPET images were performed. On visual interpretation, 22 of 27 (82%) of the Tourette's syndrome group had lesions characterized by decreased perfusion. The left hemisphere was more frequently involved. None of the children with chronic tic disorder had a visible abnormality. Semi-quantitative analysis showed that, compared with children with chronic tic disorder, children with Tourette's syndrome had significantly lower perfusion in the left lateral temporal area and asymmetric perfusion in the dorsolateral frontal, lateral and medial temporal areas. In conclusion, using the visual approach, brain SPET perfusion imaging is sensitive and specific in differentiating Tourette's syndrome and chronic tic disorder. The perfusion difference between the two groups, demonstrated by semi-quantitative analysis, may be related more to the co-morbidity in Tourette's syndrome than to tics per se.

Topics: Adolescent; Aging; Cerebrovascular Circulation; Child; Chronic Disease; Female; Humans; Male; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tic Disorders; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome

Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were studied in 75 patients with cerebral infarction. All patients were alert with the symptoms of hemiparesis and/or aphasia, and were divided into two groups: 42 patients had occlusion or stenosis of >75% at the internal carotid artery or main trunk of middle cerebral artery; and 33 patients did not. Hemispheric mean CBF was measured by performing first-pass radionuclide angiography using 99mTc-hexamethylpropylene amine oxime. CVR was measured as the percentage change from the baseline mean CBF value after the administration of 500 mg acetazolamide. The CVR in both groups was significantly impaired (5.2+/-6.3%, P<0.001 and 7.7+/-6.1%, P<0.01, respectively) compared with normal controls (14.7+/-3.3%), although the mean CBF was not significantly reduced compared with age-matched controls. In the 12 patients with unilateral carotid occlusion, five patients with good collateral flow via the anterior communicating artery showed preserved CVR (11.0+/-7.8%), but those without did not (1.6+/-7.0%). CVR is impaired in alert patients with cerebral infarction, although the mean CBF is not reduced, and good collateral flow via the anterior communicating artery in patients with carotid occlusion may be a sign of well-preserved haemodynamic status.

Topics: Acetazolamide; Adult; Aged; Aged, 80 and over; Carbonic Anhydrase Inhibitors; Carotid Stenosis; Cerebral Infarction; Cerebrovascular Circulation; Chronic Disease; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Stroke; Technetium Tc 99m Exametazime; Ventriculography, First-Pass

We performed interictal brain 99m Tc-HMPAO study in eight cases of chronic epilepsy. SPECT (single photon emission computed tomography) study showed abnormality in seven cases. As compared to computed tomography (CT) scan and electroencephalogram (EEG) which were positive in 25% and 62% cases respectively it showed abnormality in 87%. In two cases where CT scan and EEG both were normal, SPECT showed areas of hypoperfusion. In one case where EEG indicated a bilateral focus, SPECT study showed a clearly defined unilateral focal hypoperfusion defect. Areas of hyperperfusion were not seen in any of our cases. Our results indicate that HMPAO SPECT is more sensitive than CT scan and EEG, in localising an epileptogenic focus in cases of chronic epilepsy.

Topics: Adolescent; Adult; Brain; Child; Chronic Disease; Epilepsy; Humans; Male; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Although a sequential 99mTc-HMPAO SPECT technique with Diamox test (seq-SPECT) is a simple and time-saving procedure to assess brain perfusion reserve, the influence of the first dose of the tracer on the second one is not negligible. Therefore, a subtraction of the rest-SPECT from the 2nd SPECT is widely-used. However, subtracted SPECT images not only need to be corrected for the injected dose and the radiochemical purity due to inherent instability of HMPAO but also are usually degraded in quality. This study was undertaken to resolve these problems utilizing a change ratio (CR) map. The CR map was obtained by dividing 2nd SPECT by rest-SPECT. Prior to subtraction, the 2nd SPECT was normalized with the ratio of the mean whole brain counts between both SPECTs. To validate CR map, 7 patients were studied with both seq-SPECT and 133Xe inhalation CBF measurement (Xe-CBF). The right to left count ratio obtained from the ROIs placed on MCA territory of CR map correlated well with that from Xe-CBF (r = 0.89, p < 0.01). Fifty-three patients with stroke underwent the seq-SPECT which was compared with the cerebral angiography (CAG) and classified into 4 groups according to the CR map. In 25 patients, all of the rest-, the subtracted-SPECT and the CR map did not show any difference between the affected side and the contralateral normal side. Seven patients with normal rest-SPECT showed decreased subtracted-SPECT counts and CR on the affected side. Three of them showed more than 75% stenosis on CAG. Four patients with the decreased counts both at the rest- and the subtracted-SPECT revealed no difference on the CR map suggesting the matched decrease of both blood flow and metabolism in the affected side. In conclusion, the CR map was a simple and useful method to evaluate the brain perfusion reserve with the seq-SPECT.

Topics: Acetazolamide; Aged; Brain; Cerebrovascular Circulation; Cerebrovascular Disorders; Chronic Disease; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

We studied the pre and post-operative perfusion reserve using Diamox 99mTc-HMPAO SPECT in 7 patients with chronic occlusive cerebral arteries and then compared the results with PET. STA-MCA anastomosis was performed on 5 patients, while a carotid endarterectomy was done on 2 patients. The cerebral blood flow, the vascular response to CO2 or Diamox, the oxygen extraction fraction and transit time (CBV/CBF) were measured by PET. In the pre-operative state, the visual evaluations for hypoperfusion area at rest were agreed in 5 out of 7 patients in HMPAO SPECT and PET studies. In the remaining 2 patients, hypoperfusion areas were only detected in the PET study. The pre-operative evaluation of perfusion reserve was agreed in 2 patients. In the remaining 5 patients, 3 patients showed definite positive(++) in PET and positive(+) in HMPAO SPECT, and one patient showed positive (+) in PET and negative (-) in HMPAO SPECT. The post-operative change of hypoperfusion areas was well agreed in HMPAO SPECT and PET studies. However, the change of perfusion reserve was underestimated in HMPAO SPECT compared with PET. In the semiquantitative and quantitative analyses, the count rate ratios (affected/unaffected side) in HMPAO SPECT were apparently higher than those of CBF in PET. The postoperative change of the count rate ratios in HMPAO SPECT were smaller than those of CBF in PET. There was no significant correlation between the change in the ratio of the HMPAO SPECT after the administration of Diamox and the oxygen extraction fraction, and it was thus thought to be impossible to predict the areas with an increased oxygen extraction fraction. Thus, Diamox HMPAO SPECT may underestimate the areas of hypoperfusion or decrease in perfusion reserve when compared with PET. We should consider these limitations in the evaluation of pre and post operative cerebral hemodynamics.

Topics: Acetazolamide; Adult; Aged; Arterial Occlusive Diseases; Cerebral Arterial Diseases; Cerebral Revascularization; Chronic Disease; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

To investigate the sensitivity and specificity of 99mTc-HMPAO-leukocyte imaging in evaluating therapy result in patients with prosthetic joint infection (PJI) and in diagnosing suspected chronic PJI.. Sixty-two patients (63 joints) with microbiologically verified PJI were examined by leukocyte imaging to evaluate therapy result during or at the end of antibiotic treatment or if the patient had a chronic PJI after treatment. Group 1 consisted of 49 patients with on-going or within less than 14 days of ending antibiotic treatment examined to evaluate response. Group 2 consisted of 13 patients examined after completed treatment on suspicion of chronic PJI with no or recently initiated renewed antibiotic treatment. This study applied a combination of different imaging approaches of 99mTc-HMPAO-leukocyte scintigraphy: delayed and late planar images, bone marrow imaging and SPECT/CT imaging. All joints were examined with at least two of the approaches and 53 joints with all three approaches. The report was based on the combined results of the approaches used. A chronic PJI was confirmed with a positive microbiological culture. A cured infection was confirmed with either a negative culture or at least 24 months antibiotic-free follow-up with no relapse.. In the therapy evaluation group sensitivity was 0.57 and specificity was 0.81. In the suspected chronic infection group sensitivity was 1.00 and specificity 0.91.. 99mTc-HMPAO-leukocyte imaging appears to be an accurate method to diagnose or exclude chronic PJI, but cannot be recommended for therapy evaluation of PJI in patients with on-going antibiotic treatment.

Topics: Aged; Anti-Bacterial Agents; Chronic Disease; Cohort Studies; Female; Humans; Image Processing, Computer-Assisted; Joint Diseases; Leukocytes; Male; Prosthesis-Related Infections; Retrospective Studies; Technetium Tc 99m Exametazime; Treatment Outcome

Noninvasive radionuclide imaging has the potential to identify and assess mechanisms involved in particular stages of lung injury that occur with acute respiratory distress syndrome, for example. Lung uptake of (99m)Tc-hexamethylpropyleneamine oxime (HMPAO) is reported to be partially dependent on the redox status of the lung tissue whereas (99m)Tc-duramycin, a new marker of cell injury, senses cell death via apoptosis or necrosis. Thus, we investigated changes in lung uptake of these agents in rats exposed to hyperoxia for prolonged periods, a common model of acute lung injury.. Male Sprague-Dawley rats were preexposed to either normoxia (21% O(2)) or hyperoxia (85% O(2)) for up to 21 d. For imaging, the rats were anesthetized and injected intravenously with either (99m)Tc-HMPAO or (99m)Tc-duramycin (both 37-74 MBq), and planar images were acquired using a high-sensitivity modular γ-camera. Subsequently, (99m)Tc-macroagreggated albumin (37 MBq, diameter 10-40 μm) was injected intravenously, imaged, and used to define a lung region of interest. The lung-to-background ratio was used as a measure of lung uptake.. Hyperoxia exposure resulted in a 74% increase in (99m)Tc-HMPAO lung uptake, which peaked at 7 d and persisted for the 21 d of exposure. (99m)Tc-duramycin lung uptake was also maximal at 7 d of exposure but decreased to near control levels by 21 d. The sustained elevation of (99m)Tc-HMPAO uptake suggests ongoing changes in lung redox status whereas cell death appears to have subsided by 21 d.. These results suggest the potential use of (99m)Tc-HMPAO and (99m)Tc-duramycin as redox and cell-death imaging biomarkers, respectively, for the in vivo identification and assessment of different stages of lung injury.

Topics: Animals; Bacteriocins; Biological Transport; Chronic Disease; Disease Models, Animal; Hyperoxia; Lung; Male; Oxidative Stress; Peptides; Radionuclide Imaging; Rats; Rats, Sprague-Dawley; Technetium Tc 99m Exametazime

Inflammatory mediators play an important role in thrombosis etiopathology. Diagnostic radioisotopic tests can be used to assess the activity of thrombo-inflammatory process. The aim of the study was to assess the suitability of Tc-99m HMPAO labelled leukocyte scintigraphy in the diagnostics of deep vein thrombosis.. The study covered 45 patients with lower limb deep vein thrombosis treated in 2009 at the Department of Vascular, General and Transplantological Surgery of the Wrocław Medical University. Scintigraphic test were performed during the first few days after the onset of symptoms and 8 weeks later.. All patients with active deep vein thrombosis had higher levels of TC-99m-HMPAO markers in sick limbs. After 8 weeks, 93% of patients still had elevated levels of radioisotope in limbs with an active thrombosis process. However, the levels of markers were clearly lower than in the acute phase of thrombosis.. 1. In the chronic phase of thrombosis, 93% of patients still have higher levels of radioisotopic markers, which indicates an active inflammatory process. 2. Tc-99m HMPAO labelled leukocyte scintigraphy demonstrates high sensitivity in the diagnostics of deep vein thrombosis.

Topics: Chronic Disease; Humans; Leukocytes; Lower Extremity; Radionuclide Imaging; Technetium Tc 99m Exametazime; Venous Thrombosis

Although endoscopy with biopsy is the gold standard for the diagnosis of inflammatory bowel disease (IBD), this procedure is invasive and its repetition is stressful, especially in children. The purpose of this study was to evaluate prospectively the role of (99m)Tc-HMPAO-labeled granulocyte scintigraphy in the diagnosis and follow-up of pediatric IBD and its possible use as an alternative to colonoscopy to determine the disease extent and severity beyond its ability to differentiate ulcerative colitis from Crohn's disease. During a 10-year period, 52 children, aging between 2 and 17 years (median, 11.09 years), were subjected to (99m)Tc-HMPAO granulocyte scan 7-28 days from conventional diagnostic tests, and the results were compared with endoscopic and bioptic results. Disease severity was graded by the focal uptake intensity versus iliac bone uptake (Scan Activity Index) and compared with Endoscopy Mayo Score. In 15 out of 16 patients, IBD diagnosis was obtained with a full correspondence of location and severity of lesions, respectively, in 14 out of 16 and 13 out of 16, while in 31 out of 36 patients, IBD was correctly excluded (sensitivity of 93.7%, specificity of 86.1%, and negative predictive value of 96.4%). During the follow-up, all relapses (24) and remissions (13) were correctly recognized (sensibility and specificity of 100%). In conclusion, (99m)Tc-HMPAO granulocyte scan is an accurate minimally invasive technique with very good accuracy, able to diagnose and to grade the intensity and extent of the disease; it is also a useful tool in the follow-up of pediatric IBD where it could reliably replace the invasive endoscopic assessment in most cases.

Topics: Adolescent; Biopsy; Child; Child, Preschool; Chronic Disease; Diagnosis, Differential; Endoscopes, Gastrointestinal; Female; Follow-Up Studies; Granulocytes; Humans; Inflammatory Bowel Diseases; Intestines; Male; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Exametazime

To investigate the kinetics of myocardial engraftment of bone marrow-derived mononuclear cells (BMNCs) after intracoronary injection using 99mTc-d,l-hexamethylpropylene amine oxime (99mTc-HMPAO) nuclear imaging in patients with acute and chronic anterior myocardial infarction.. Nuclear imaging-derived tracking of BMNCs at 2 and 20 h after injection in the left anterior descending (LAD) coronary artery.. Academical cardiocentre.. Five patients with acute (mean (SD) age 58 (11) years; ejection fraction range 33-45%) and five patients with chronic (mean (SD) age 50 (6) years; ejection fraction range 28-34%) anterior myocardial infarction.. A total of 24.2 x 10(8)-57.0 x 10(8) BMNCs (20% labelled with 700-1000 MBq 99mTc-HMPAO) were injected in the LAD coronary artery.. At 2 h after BMNC injection, myocardial activity was observed in all patients with acute (range 1.31-5.10%) and in all but one patient with chronic infarction (range 1.10-3.0%). At 20 h, myocardial engraftment was noted only in three patients with acute myocardial infarction, whereas no myocardial activity was noted in any patient with chronic infarction.. Engraftment of BMNCs shows dynamic changes within the first 20 h after intracoronary injection. Persistent myocardial engraftment was noted only in a subset of patients with acute myocardial infarction.

Topics: Acute Disease; Aged; Bone Marrow Cells; Bone Marrow Transplantation; Chronic Disease; Coronary Vessels; Graft Survival; Humans; Injections, Intralesional; Male; Middle Aged; Myocardial Infarction; Pharmacokinetics; Radionuclide Imaging; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Exametazime

A cross-sectional study to investigate regional cerebral blood flow (rCBF) in patients with chronic whiplash syndrome and chronic neck pain patients without previous history of trauma along with a healthy control group. Chronic neck pain is a common disorder and a history of cervical spine injury including whiplash trauma constitute a risk factor for persistent neck pain. The aetiology of the late whiplash syndrome is unknown with no specific diagnostic criteria based on imaging, physiological, or psychological examination. Earlier studies indicate a parieto-occipital hypoperfusion but it is unclear if the hypoperfusion represents a response to chronic pain. The rCBF was monitored in 45 patients with chronic neck pain: 27 cases with chronic whiplash syndrome and 18 age and gender matched cases with non-traumatic chronic neck pain. The rCBF was estimated with single-photon emission computed tomography (SPECT) using technetium-99m hexamethylpropylene amine oxime (HMPAO). The non-traumatic patients displayed rCBF changes in comparison with the whiplash group and the healthy control group. These changes included rCBF decreases in a right temporal region close to hippocampus, and increased rCBF in left insula. The whiplash group displayed no significant differences in rCBF in comparison with the healthy controls. The present study suggests different pain mechanisms in patients with chronic neck pain of non-traumatic origin compared to those with chronic neck pain due to a whiplash trauma.

Topics: Adult; Chronic Disease; Female; Humans; Male; Middle Aged; Neck Pain; Regional Blood Flow; Technetium Tc 99m Exametazime; Telencephalon; Tomography, Emission-Computed, Single-Photon; Whiplash Injuries

The purpose of this study was to investigate the cerebral blood flow changes associated with the analgesic effect of acupuncture in patients with chronic pain.. Seven patients presenting with a chronic pain syndrome and 5 healthy controls were included. All single-photon emission computed tomography (SPECT) scans were acquired with a uniform protocol. The patient group was injected with the radioisotope hexamethyl propyleneamine oxime (HMPAO) while experiencing their usual level of pain. A baseline scan was acquired approximately 20 minutes after administration of the HMPAO. The patient then underwent acupuncture therapy with needles placed in points specifically selected to relieve pain. When the pain improved, as determined by a 10-digit score for pain assessment, the patient was reinjected with HMPAO and imaged 20 minutes later for the acupuncture scan. The reference group also had a baseline and acupuncture scan, although the acupuncture itself was performed using a standardized set of needle points.. The reference group participants were found to have significant increases in the thalamic and prefrontal cortex activity on the acupuncture scan compared to the baseline. The baseline scans of the pain patients showed significant asymmetric uptake in the thalami compared to controls. This asymmetry reversed or normalized after the acupuncture therapy. Significant correlations were observed between the change of activity in the prefrontal cortex and ipsilateral sensorimotor area.. The results from these cases show that HMPAO-SPECT is capable of detecting changes in cerebral blood flow associated with pain and that acupuncture analgesia is associated with changes in the activity of the frontal lobes, brain stem, and thalami.

Topics: Acupuncture Analgesia; Adult; Brain; Cerebrovascular Circulation; Chronic Disease; Female; Humans; Male; Middle Aged; Pain; Pain Management; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Chronic Disease; Female; Femur; Fistula; Humans; Leukocytes; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Skin; Soft Tissue Infections; Technetium Tc 99m Exametazime

Topics: Brain; Cerebral Infarction; Chronic Disease; Heart Ventricles; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Middle Aged; Persistent Vegetative State; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Thrombosis; Ventricular Dysfunction, Left

There have been few direct comparisons between MR perfusion-weighted imaging (PWI) and established perfusion imaging techniques, and none in chronic stroke. We therefore studied 17 chronic hemispheric infarction patients (mean, 90 days) and compared hypoperfusion volumes determined from PWI maps of relative cerebral blood flow (rCBF) and volume (rCBV), and mean transit time (rMTT) with those measured with (99)Tc-HMPAO single photon emission computed tomography (SPECT). Comparisons were also made between infarct size (T(2)-WI) and clinical scales. Correlations were found between lesion location and volume in all three PWI hemodynamic parameter maps with clinical state and lesions on SPECT and T(2)-WI. In 3 patients, rCBF and rCBV lesions extended well beyond the borders of moderate-sized infarctions. We conclude that in chronic stroke, PWI can delineate regions of abnormal perfusion that reflect the degree of functional impairment and structural damage. The finding of peri-infarct hypoperfusion suggests that PWI may have the potential to provide a rapid and non-invasive template against which interventional strategies aimed at promoting functional recovery may be investigated.

Topics: Aged; Aged, 80 and over; Brain Infarction; Cerebrovascular Circulation; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Benign intracranial hypertension (BIH) is characterized by symptoms and signs of raised intracranial pressure in the absence of an intracranial mass lesion, infection or hydrocephalus. The purpose of this study was to evaluate the effect of disease severity on cerebral blood flow in patients with BIH on acetazolamide therapy.. 11 patients (nine females, two males; mean age 30.5 years; range 22-29 years) with BIH were studied. All patients underwent CT and MRI scanning which were normal. The CSF pressure of all patients was above 200 mm H2O. All patients were under treatment with acetazolamide (1 g/day). Disease severity was determined by visual field examination and by clinical symptoms. Five patients were categorized into mild to moderate BIH (group I) and six patients had severe BIH (group II). All patients underwent perfusion brain SPECT with 740 MBq of Tc-99m-HMPAO.. Brain perfusion abnormalities were observed in six of the 11 patients. One out of five patients in group I (20%) and five out of six patients (83%) in group II, had abnormal SPECT findings (P<0.04). In four patients of group II the left parietal lobe was involved and another patient had a right occipital abnormality. The single patient from group I with SPECT abnormalities demonstrated focal decreased perfusion in the left temporal area and decreased perfusion in the left caudate nucleus.. Patients with severe degree of BIH have a higher incidence of cerebral perfusion abnormalities. This group may have an increased risk of cerebrovascular complications. The continuous administration of acetazolamide which affects the vascular autoreactivity may contribute to the regional hypoperfusion. Further studies are recommended to evaluate the natural course of disease versus iatrogenic treatment effects.

Topics: Acetazolamide; Adult; Brain; Cerebrovascular Circulation; Chronic Disease; Diuretics; Female; Humans; Male; Pseudotumor Cerebri; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

99mTc-labeled ciprofloxacin (infecton) has been developed for detecting infectious foci, which localize in high concentrations in living bacteria. Other studies performed with various infections in animals and humans have found that infecton is a promising agent with better specificity for bacterial infections than white blood cell (WBC) scans. In this study, we evaluated the efficacy of infecton scintigraphy for detecting chronic bone and joint infections.. Fifty-six sites with suspected bone or joint infection were examined with 99mTc-WBC and infecton scans in 51 patients. Of these patients, 21 had prosthetic implant materials. Biochemical, radiologic, and microbiologic data and clinical outcomes also contributed, along with the results from scintigraphic techniques, in determining the presence or absence of infection. Scintigraphic images were produced at 1 and 4 h after injection of 370-400 MBq infecton or 185-200 MBq 99mTc-hexamethylpropyleneamine oxime (HMPAO)-WBCs. For each patient, there were at least 2 d and at most 7 d between scintigraphic studies.. There were 30 true-positive, 4 false-positive, 20 true-negative, and 2 false-negative results with infecton. With 99mTc-HMPAO-WBCs, the results were 20, 1, 23, and 12, respectively. Values for sensitivity, specificity, and accuracy were 94%, 83%, and 89%, respectively, with the infecton scan and 63%, 96%, and 77%, respectively, with WBC scanning. Differences between the two agents were statistically significant (P < 0.001). Infecton and WBC scan results were in general concordance for 43 of 56 sites (77%). Infecton results for vertebral infections were the most notable findings in this study, despite the limited number of patients with this condition. Infecton scans were positive for hot spots in five of six patients with vertebral osteomyelitis. WBC scans showed photon-deficient areas in four of these same patients and normal distribution in the remaining two patients.. Infecton is a useful agent for detecting infectious foci in bones and joints. Moreover, the infecton scan seems to be a more powerful tool in diagnosing vertebral infections than WBC scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Bone and Bones; Child; Child, Preschool; Chronic Disease; Ciprofloxacin; Female; Humans; Infant; Joint Diseases; Joints; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Prospective Studies; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Soft Tissue Infections; Technetium Tc 99m Exametazime

In order to evaluate the importance of 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) leukocyte scintigraphy in the diagnosis of bone infection, we retrospectively reviewed 324 patients. Abnormal findings were seen in 221 patients. In the other 103 cases acute pathological inflammation could be ruled out. The patients with pathological findings were divided into four groups according to the location of the infection. This method showed the localizations of skeletal disorders and its differences to other diagnostic imaging modalities. The underlying abnormalities causing the inflammation were determined. In conclusion, 99mTc-HMPAO leukocyte scintigraphy is still a very sensitive method for either whole body screening or local detection of acute or exacerbated chronic osteomyelitis. The advantages of this method over other diagnostic imaging methods are shown.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement; Bone Diseases, Infectious; Chronic Disease; Female; Humans; Inflammation; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Exametazime; Wounds and Injuries

Cerebral blood flow (CBF) measured by 99mTc-HMPAO SPECT before operation was studied in 60 patients with unilateral chronic subdural hematoma. The regional CBF was measured in 26 regions of the fronto-occipital 10 cortices, putamen, thalamus and cerebellar hemisphere on both sides. Sixty cases with unilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 17 cases with headache (headache group), 34 cases with hemiparesis (hemiparesis group) and 9 cases with consciousness disturbance or dementia (consciousness disturbance group), and into three groups on the basis of the degree of midline brain shift on MRI: 7 cases of mild shift group, 24 cases of moderate shift group and 29 cases of severe shift group. The average CBF in 60 patients in each region indicated that the regional CBF was reduced in frontal, occipital cortices and cerebellum on the non-hematoma side, and in putamen and thalamus on the hematoma side. In the headache group, the regional CBF reduction on the non-hematoma side was found in only frontal and occipital cortices compared with the corresponding regions on the hematoma side. In the hemiparesis group, the regional CBF was reduced in frontal and occipital cortices on the non-hematoma side and in putamen and thalamus on the hematoma side. The part of CBF reduction in both hemispheres was also noted in the hemiparesis group. In the consciousness disturbance group, the CBF reduction was markedly noted in whole brain. The CBF reductions in frontal and occipital cortices on the non-hematoma side and in putamen, thalamus and cerebellum on the hematoma side was not mutually related with the degree of midline brain shift. We concluded that the disturbance of CBF in chronic subdural hematoma was started from frontal and occipital cortices on the non-hematoma side observed in the headache group, and which was extended to putamen and thalamus on the hematoma side and a part of both hemispheres observed in the hemiparesis group. And such disturbance was finally observed as the CBF reductions in whole brain in the consciousness disturbance group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cerebellum; Cerebrovascular Circulation; Chronic Disease; Consciousness Disorders; Female; Headache; Hematoma, Subdural; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paresis; Putamen; Radiopharmaceuticals; Regional Blood Flow; Technetium Tc 99m Exametazime; Thalamus; Tomography, Emission-Computed, Single-Photon

In this case study, the significance of perfusion abnormalities in catatonia is examined.. Recurrent catatonic symptoms are frequently observed in psychiatric disorders, but the predictors of relapse of the catatonic symptoms remain unknown. Perfusion abnormalities have been reported during catatonic states; however, little is known about brain functioning of catatonic patients during remission.. A catatonic patient was evaluated by clinical interview, behavioral examination, and functional neuroimaging (single photon emission computed tomography) to determine diagnosis and brain perfusion.. The patient exhibited persistent hypoperfusion of the basal ganglia even after achieving symptomatic remission.. These findings predict a secondary cause and may predict a chronic course.

Topics: Adult; Basal Ganglia; Brain; Catatonia; Chronic Disease; Functional Laterality; Humans; Male; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Cerebral blood flow(CBF) in 34 patients with bilateral chronic subdural hematoma was measured by 99mTc-HMPAO SPECT before operation. The regional CBF was measured in 26 regions of the 10 cortical regions, putamen, thalamus and cerebellar hemisphere on both sides. According to the thickness of subdural hematoma, the thicker hematoma side was measured and examined as the thick hematoma side, and the other side as the thin hematoma side. Thirty four cases with bilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 13 cases with headache(headache group), 10 cases with hemiparesis(hemiparesis group), 5 cases with tetraparesis(tetraparesis group) and 6 cases with consciousness disturbance or dementia(consciousness disturbance group), and into two groups according to the degree of midline brain shift on MRI: 14 cases of non-shifted group and 20 cases of shifted group. The average CBF of 34 patients in each region indicated a regional CBF reduction in the frontal, parietal and occipital cortices on the thin hematoma side, and in the putamen on the thick hematoma side. In the headache group, the regional CBF reduction on the thin hematoma side was found in the frontal, parietal and occipital cortices compared with the corresponding regions on the thick hematoma side, and in thalamus on the thick hematoma side. In the hemiparesis and tetraparesis groups, there was no statistically significant CBF reduction between the thick and thin hematoma sides. In the consciousness disturbance group, the CBF reduction in whole brain was remarkably significant. By the degree of the midline brain shift, the CBF reductions between the thick and thin hematoma sides were observed. Namely, in the shifted group, the CBF reductions were noted in the frontal, parietal and occipital cortices in the thin hematoma side, and in the putamen in the thick hematoma side. We concluded that the CBF reduction of bilateral chronic subdural hematoma was bilaterally found in the hemiparesis and tetraparesis groups, and which was finally observed in whole brain in the consciousness disturbance group.

Topics: Adult; Aged; Aged, 80 and over; Blood Volume; Cerebral Cortex; Cerebrovascular Circulation; Chronic Disease; Consciousness Disorders; Female; Headache; Hematoma, Subdural; Hemiplegia; Humans; Male; Middle Aged; Quadriplegia; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Exametazime

The authors report a 61-year-old man with chronic viral encephalitis and Koshevnikov syndrome occurring 42 months after initial symptom of right hemiparesis. Serial computed tomography of the brain showed changes in the attenuation of the left temporal lobe lesion over time. Magnetic resonance images of the brain showed enlargement of left temporoparietooccipital lobes with cortical gyral enhancement on T1-weighted images following intravenous administration of gadolinium-DTPA. 99mTc-HMPAO single-photon emission computerized tomography showed increased radioactivity and hyperperfusion in the left temporoparietal region with paradoxically decreased local tissue perfusion at the contralateral right hemisphere. Follow-up magnetic resonance images of the brain 4 years later showed atrophy of bilateral cerebral hemispheres. We postulate that a "transcallosal diaschisis" with subsequent degeneration is a possible mechanism. A brain biopsy from the left temporal lobe lesion showed pictures compatible with viral encephalitis probably herpes simplex encephalitis.

Topics: Atrophy; Brain; Brain Diseases; Cerebrovascular Circulation; Chronic Disease; Contrast Media; Corpus Callosum; Encephalitis, Viral; Epilepsia Partialis Continua; Follow-Up Studies; Gadolinium DTPA; Herpes Simplex; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Occipital Lobe; Parietal Lobe; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To examine the role of structural (magnetic resonance imaging [MRI]) and functional (single photon emission computed tomography [SPECT]) imaging and neuropsychologic evaluation in the early diagnosis of frontal variant frontotemporal dementia (fvFTD).. Current criteria for FTD stress the need for neuropsychologic and functional neuroimaging abnormalities, yet caregivers report lengthy histories of behavioral change. It is not known when, in the course of the disease, these investigations become abnormal, because few longitudinal studies have been reported.. Longitudinal study of two patients with serial neuropsychologic evaluation and MRI and HMPAO-SPECT scanning.. Both patients, men aged 49 and 50, had major changes in personality, behavior, and social conduct that progressed over 5 to 6 years in a way that conformed to the clinical picture of fvFTD. There was remarkably little abnormality on neuropsychologic testing, and MRI and HMPAO-SPECT findings initially were normal. Over time, however, abnormalities on SPECT, frontal atrophy on MRI, or a neuropsychologic profile more typical of fvFTD developed in both patients.. Standard neuropsychologic tests and conventional brain imaging techniques (MRI and SPECT) may not be sensitive to the early changes in fvFTD that occur in the ventromedial frontal cortex, and better methods of accurate early detection are required. These findings are relevant to the diagnostic criteria for FTD.

Topics: Atrophy; Chronic Disease; Cognition Disorders; Dementia; Disease Progression; Frontal Lobe; Humans; Irritable Mood; Longitudinal Studies; Magnetic Resonance Imaging; Male; Memory Disorders; Middle Aged; Neuropsychological Tests; Personality Disorders; Sensitivity and Specificity; Social Behavior Disorders; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Chronic Disease; Crohn Disease; Diagnosis, Differential; Hemoglobinuria, Paroxysmal; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Exametazime

The main goal of the present study was to explore whether regional cerebral blood flow (rCBF) differs between obsessive-compulsive disorder (OCD) patients without chronic motor tic disorder and those OCD patients with a comorbid chronic tic disorder. Twenty-seven patients suffering from OCD (DSM-IV criteria), including 7 OCD patients who met DSM-IV criteria for simple chronic motor dic disorder, and 16 healthy volunteers were examined at rest using a high resolution SPECT. Seven regions of interest (ROIs) were manually traced and quantified as a percentage of the mean cerebellar uptake. Severity of obsessive-compulsive symptoms (OCS), anxiety and depressive symptoms and presence of motor tics were assessed with the Y-BOCS, HRS-A, HRS-D, MADRS, and Yale Global Tics Severity Scale, respectively. We found a significant relative decrease in rCBF in OCD patients without motor tics compared to healthy volunteers in the right orbitofrontal cortex (OCD without tics = 0.87; healthy volunteers = 0.94; p = 0.02). No significant differences in rCBF were seen when OCD patients with and without chronic tics were directly compared. A lower severity of OCS in OCD patients with chronic tics was found. These results are consistent with previous functional neuroimaging studies at rest that have widely involved the orbitofrontal cortex in the pathophysiology of the OCD. However, our results do not support the idea that OCD patients with chronic tics may constitute a biological subgroup within the OCD.

Topics: Adult; Analysis of Variance; Brain; Chronic Disease; Female; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Exametazime; Tic Disorders; Tomography, Emission-Computed, Single-Photon

Topics: Acute Disease; Aged; Chronic Disease; Female; Humans; Intestine, Small; Ischemia; Leukocytes; Mesentery; Radionuclide Imaging; Technetium Tc 99m Exametazime

Posttraumatic osteomyelitis was investigated in 23 patients using nuclear medicine techniques. Tc-99m hexamethylpropilene amine oxime (HMPAO)-labeled leukocyte scintigraphy was performed in 11 patients, and Tc-99m nanocolloid scanning was performed in the other 12 patients. The scintigraphic findings were compared with clinical, laboratory, radiologic, and bacteriologic results. The findings on leukocyte imaging were consistent with the clinical symptoms in 7 of 11 patients, with the laboratory pattern in 7 of 10 patients, with the radiologic findings in 7 of 11 patients, and with the results of bacteriology in 6 of 7 patients. The findings on nanocolloid scintigraphy corresponded with the clinical symptoms in 9 of 12 patients, with the laboratory pattern in 8 of 10 patients, with the radiologic findings in 8 of 12 patients, and with the bacteriology in 4 of 5 patients. The results suggest that both methods were of similar value for the detection of chronic posttraumatic osteomyelitis regardless of whether the process was active. Conversely, on the basis of semiquantitative analysis of the images, leukocyte scintigraphy seemed to characterize the grade of inflammation better than did nanocolloid scintigraphy.

Topics: Adult; Aged; Bone and Bones; Chronic Disease; Escherichia coli Infections; Female; Femur; Follow-Up Studies; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Proteus Infections; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Staphylococcal Infections; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Exametazime; Thumb; Tibia

We examined patterns of regional cerebral blood flow (rCBF) abnormalities in 18 patients with major depressive disorder in late life using single photon emission computed tomography (SPECT) and 99mTc-hexamethylpropylenamine oxime (99mTc-HMPAO). Compared with 13 age-matched controls, relative rCBF was significantly decreased bilaterally in the anterior cingulate gyrus, the prefrontal cortex, the temporal cortex, the parietal cortex, the hippocampus and the caudate nucleus. However, it was not correlated with the severity of depression or global cognitive dysfunction. In 10 patients with a prolonged depressive episode or prolonged residual symptoms (the refractory subgroup), robust and extensive decreases in rCBF were found compared with controls and the rCBF decreased significantly in the anterior cingulate gyrus and the prefrontal cortex compared with that in the non-refractory subgroup. In the non-refractory subgroup, rCBF decreased significantly in the caudate nucleus and tended to decrease in the anterior cingulate gyrus compared with controls. These findings indicate that dysfunction of the limbic system, the cerebral association cortex and the caudate nucleus may be implicated in late-life depression and that robust and extensive hypoperfusion, especially in the anterior cingulate and the prefrontal regions, may relate to refractoriness or chronification of depression.

Topics: Aged; Brain; Brain Mapping; Caudate Nucleus; Cerebral Cortex; Chronic Disease; Depressive Disorder, Major; Dominance, Cerebral; Female; Gyrus Cinguli; Humans; Limbic System; Male; Middle Aged; Recurrence; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Functional neuroimaging studies in schizophrenia have often been confounded by various factors including medication status. To explore the effects of antipsychotic medications on relative regional cerebral perfusion, we scanned a group of 33 persons with schizophrenia twice, while receiving a stable dose of antipsychotic and after being off antipsychotics for 3 weeks, using technetium-99m hexamethyl-propyleneamine oxime single photon emission computed tomography (Tc-99m HMPAO-SPECT. We found that antipsychotic significantly increased the mean relative cerebral perfusion in the left basal ganglia. Additionally, patients receiving thiothixene (n = 9) had a significantly greater increase in relative cerebral perfusion in the basal ganglia than patients receiving haloperidol (n = 12). These findings indicate that antipsychotics lead to regional increases in cerebral perfusion and that antipsychotic status must be controlled for in functional neuroimaging studies. Functional neuroimaging techniques such as SPECT may be useful in furthering our understanding of the mechanism of antipsychotics.

Topics: Adult; Antipsychotic Agents; Basal Ganglia; Brain; Brain Mapping; Cerebellum; Cerebral Cortex; Chronic Disease; Clozapine; Female; Haloperidol; Humans; Male; Organotechnetium Compounds; Oximes; Psychiatric Status Rating Scales; Regional Blood Flow; Schizophrenia; Schizophrenic Psychology; Technetium Tc 99m Exametazime; Thiothixene; Tomography, Emission-Computed, Single-Photon; Trifluoperazine

There is a well recognized clinical overlap between primary and secondary neuroleptic negative symptoms in schizophrenia, but their cerebral substrates are probably different. The study of these substrates could contribute to a better understanding and management of these syndromes. In the present work, the cerebral perfusion correlates, as an indirect measure of the underlying neuronal function, of negative symptoms and parkinsonism were studied with single-photon emission tomography in a group of treatment-refractory paranoid schizophrenic patients. Perfusion ratios with respect to the homolateral cerebellum were compared with a normal database. Correlation coefficients were calculated between perfusion ratios, negative symptoms and parkinsonism scores on exploratory grounds. As a group, the patients showed a bilateral, but predominantly left-sided, hypofrontality and hypotemporality, as well as an increased perfusion in right basal ganglia. Negative symptoms scores negatively correlated with prefrontal perfusion, while parkinsonism positively correlated with the activity of primary motor and sensory cortex. These findings support the existence of different cerebral substrates for primary and secondary negative symptoms in schizophrenia.

Topics: Adult; Antipsychotic Agents; Brain; Brain Mapping; Chronic Disease; Depression; Dominance, Cerebral; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Parkinson Disease, Secondary; Psychiatric Status Rating Scales; Regional Blood Flow; Schizophrenia, Paranoid; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Treatment Failure

The effect of enalapril on cerebral blood flow (CBF) was studied in 11 patients with chronic heart failure (NYHA II or III, dilated cardiomyopathy in 6 and old myocardial infarction in 5). CBF was evaluated by analyzing the Patlak-Plot curve obtained from radionuclide angiography with technetium-99m hexamethylpropylene amine oxime (99mTC-HM-PAO). Cardiac index (CI) and stroke volume (SV) were simultaneously measured by impedance cardiography. These measurements were performed before and at four weeks after daily administration of 5 mg enalapril. The stroke volume, cardiac index, and heart rate were not significantly changed after four weeks of enalapril administration. However, CBF was increased by 6.5% from 36.72 +/- 4.66 to 39.13 +/- 5.65 mL/100g/min (P < 0.05). These results suggest that enalapril increased cerebral blood flow, which was not related to increased cardiac output in congestive heart failure. Patlak-Plot analysis of radionuclide angiography using 99mTC-HM-PAO may be available for quantitative assessment of brain perfusion.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Blood Flow Velocity; Cardiac Output; Cardiomyopathy, Dilated; Cerebrovascular Circulation; Chronic Disease; Enalapril; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Angiography; Stroke Volume; Technetium Tc 99m Exametazime

To evaluate the diagnostic value of technetium-99m d, l-hexamethylpropylene amine oxime (HMPAO) labelled leucocytes in combination with a 99mTc-methylene diphosphonate (MDP) bone scan in the detection of chronic osteomyelitis, we retrospectively reviewed 55 patients. Prior to the 99mTc-d,l-HMPAO labelled leucocyte scan, all patients underwent a 99mTc-MDP bone scan. The correct diagnosis was confirmed by long-term clinical follow-up (n=29) or by bacteriological cultures (n=26). We found an overall sensitivity of 94%, a specificity of 91% and an accuracy of 92% for 99mTc-d,l-HMPAO labelled leucocyte scintigraphy in the diagnosis of chronic osteomyelitis. When the patients were divided into three groups according to the location of the infection, our study results showed a sensitivity and specificity for the central location (containing active bone marrow) of 94% and 100% respectively; for the peripheral location (hands and feet) both parameters were 100%, and for the middle location (all sites between the central and the peripheral location) the values were 92% and 81% respectively. Specificity and accuracy were significantly lower in the middle location than in the central and peripheral locations. The results of our study confirm that a 99mTc-d,l-HMPAO labelled leucocyte scan in combination with an 99mTc-MDP bone scan is a reliable way to diagnose chronic osteomyelitis, except for vertebral osteomyelitis.

Topics: Case-Control Studies; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

The aim of this study was to investigate the ability of 111In-labelled human polyclonal immunoglobulin G (111In-IgG) to localize bone and joint infections compared with 99Tcm-HMAPO-labelled leukocytes (99Tcm-WBC). Thirty-four patients routinely referred for investigation of bone and joint infections were studied. In all patients, a bone scan using 99Tcm-MDP was initially obtained. Subsequently, 99Tcm-WBC and 111In-IgG were simultaneously injected and images obtained at 30 min, 4 h and 24 h post-injection. Diagnostic accuracy was established by bacteriology of specimens obtained by needle aspiration and/or surgery, other imaging methods and clinical follow-up. The images were read by three experienced observers blinded to any other information; the clinical suspicion of infection and the diagnosis were established when two observers agreed. Infection was confirmed in 11 patients. The 99Tcm-WBC scans gave 8 true-positive, 5 false-positive, 18 true-negative and 3 false-negative results. With 111In-IgG, the figures were 7, 6, 17 and 4, respectively. The sensitivity, specificity and accuracy were 72.7%, 78.2% and 76.4% respectively for the labelled leukocytes and 63.6%, 73.9% and 70.6% respectively for 111In-IgG. There was greater agreement between the observers with 99Tcm-WBC than 111In-IgG. In this study, 111In-IgG was less sensitive and less specific than 99Tcm-WBC scintigraphy for the diagnosis of chronic infections, but these differences were not significant. Both tracers appear to be useful in the diagnosis of bone and joint infections. However, our results were less reliable for the diagnosis of an infected prosthesis.

Topics: Adult; Aged; Aged, 80 and over; Bone Diseases; Chronic Disease; Diagnostic Errors; Female; Hip Prosthesis; Humans; Immunoglobulin G; Indium Radioisotopes; Infections; Joint Diseases; Knee Prosthesis; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radioimmunodetection; Technetium Tc 99m Exametazime

To investigate the utility of neuroreceptor imaging in ischaemic cerebrovascular disorders, dual-tracer autoradiography using 99Tcm-hexamethylpropyleneamine oxime (HMPAO) for the evaluation of cerebral blood flow and 125I-iomazenil for the evaluation of central-type benzodiazepine receptor density was performed in experimental brain ischaemia created by occlusion of the unilateral middle cerebral artery of the rat. In the acute phase of ischaemia, 125I-iomazenil accumulation showed less of a decrease than 99Tcm-HMPAO in the cerebral cortex of the lateral convexity and in the lateral segment of the caudate putamen in the lesioned cerebral hemisphere. In the sub-acute phase, both 125I-iomazenil and 99Tcm-HMPAO accumulation increased in the lesion compared with the acute phase. A large accumulation of 99Tcm-HMPAO and 125I-iomazenil in the lesion was considered to be due to luxury perfusion and penetration of 125I-iomazenil hydrophilic metabolites from the blood into the brain tissue through the altered blood-brain barrier. In the chronic phase, 125I-iomazenil accumulation showed a more marked decrease than 99Tcm-HMPAO in the lesion. Moreover, the ipsilateral thalamus, which is remote from the lesion, revealed decreased 125I-iomazenil accumulation despite normal 99Tcm-HMPAO accumulation. Since the central-type benzodiazepine receptors are principally located not on the glial cells but on the neurons, the receptor density may exhibit a change that parallels the neuron density. These results suggest that central-type benzodiazepine receptor imaging is useful for the evaluation of neuronal damage when used in conjunction with brain perfusion imaging in ischaemic cerebrovascular disorders, except in the sub-acute phase.

Topics: Acute Disease; Animals; Autoradiography; Brain; Brain Ischemia; Chronic Disease; Flumazenil; Functional Laterality; Iodine Radioisotopes; Male; Organ Specificity; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Rats; Rats, Inbred Strains; Receptors, GABA-A; Technetium Tc 99m Exametazime

Chronic mesenteric ischaemia is often difficult to diagnose. A high level of clinical suspicion is needed and further investigation requires invasive procedures. We present a case where weight loss and abdominal pain were dominant features and initial interpretation of a labelled leucocyte scan suggested inflammatory bowel disease. Subsequent investigations excluded this possibility and chronic ischaemia was confirmed at autopsy. Positive small bowel images using 99Tcm-HMPAO labelled leucocytes may indicate chronic ischaemia.

Topics: Aged; Chronic Disease; Fatal Outcome; Female; Humans; Intestine, Small; Leukocytes; Mesenteric Vascular Occlusion; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Thrombosis

Nonspecific osteomyelitis in children and adolescents can be diagnosed in patients 2 to 16 years old and may present as acute, subacute or chronic. During the last 9 years, 40 pediatric patients (aged 2 to 16 years) affected with extra-axial inflammatory bone lesions were examined. The series of cases was then reviewed. This work was aimed at investigating the role of various imaging modalities: conventional radiology (CR), bone scan with technetium-99 methylene diphosphonate (99mTc-MDP), scintigraphy with technetium-esamethylpropylenaminoxima labelled leukocytes (99mTc-HMPAO), computed tomography (CT) and magnetic resonance imaging (MRI) were used to detect the lesions, to make a differential diagnosis and to assess different disease stages. As for acute osteomyelitis (6 patients), CR showed a lytic lesion, periosteal new bone and soft tissue swelling in 4/6 patients; no abnormalities were demonstrated in the other two. Bone scan, CT and MRI depicted bone involvement. CT and MRI also showed inflammatory lesion spread to surrounding soft tissue. 99mTc-HMPAO scintigraphy was not performed in acute osteomyelitis, because of technical difficulties in performing the exam promptly; thus, the early diagnosis of lesion nature was made with bone biopsy. As for subacute osteomyelitis (23 patients), 99mTc-HMPAO scintigraphy was performed in 8/23 patients and proved to be a highly sensitive method, showing cell clusters and confirming the diagnosis of inflammatory lesion. MRI showed a focal area of intermediate-low signal intensity on T1-weighted sequences, with small focal intralesional areas of low intensity, a low-signal perifocal rim and diffusely low signal of surrounding bone marrow. T2-weighted images showed high signal intensity in both the abscess lesion and bone marrow, the latter probably due to edema. In 5 patients, a paramagnetic contrast agent (Gd-DTPA) was administered during MRI and showed inhomogeneous enhancement of both the inflammatory lesion and surrounding bone marrow. As for chronic osteomyelitis (7 patients), MRI was performed in 5/7 patients. In 4 patients the lesion appeared as a low-signal area on T1-weighted images while T2-weighted images showed an inhomogeneous high-signal area. In the same patients, 99mTc-HMPAO scintigraphy was always positive. In patient 5, the lesion was represented by a low-signal area on both T1 and T2-weighted images, while 99mTc-HMPAO was negative. Therefore, in chronic osteomyelitis, both MRI and 99mTc-HMPAO wer

Topics: Acute Disease; Adolescent; Biopsy; Bone and Bones; Child; Child, Preschool; Chronic Disease; Contrast Media; Female; Gadolinium; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Organometallic Compounds; Organotechnetium Compounds; Osteomyelitis; Oximes; Pentetic Acid; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Dementia in parkinsonian patients is estimated to 10-40%. Several factors may take part in the development of cognitive impairment: i/ defective function of subcortico-cortical pathways including the mesocorticolimbic dopamine deficiency with cell loss in medial substantia nigra, the degeneration of noradrenergic, serotonergic and cholinergic systems ii/ cortical and limbic Alzheimer pathology iii/ cortical Lewy bodies iv/ vascular alterations. Using HMPAO SPECT we distinguished three main types of hypoperfusion in Parkinson patients with dementia: i/ predominantly frontal lobe type ii/ posterior ("Alzheimer-like") type iii/ multiple small vascular defects. Neuropsychological investigation was based on the use of MMSE, word pair, digit span, verbal fluency, Lurija's tapping tests. In addition CURS and Hachinski's score were also applied. Selegiline (JumexR) therapy was introduced and the patients were followed for at least 60 days. Selegiline improved significantly the MMSE values and verbal fluency in the "frontal lobe" type further the memory functions in "Alzheimer-like" patients. The mechanism is still not clarified, the increased dopaminergic tone should be taken into account.

Topics: Antiparkinson Agents; Brain; Chronic Disease; Dementia; Dopamine; Humans; Neuropsychological Tests; Organotechnetium Compounds; Oximes; Parkinson Disease; Selegiline; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

To evaluate the relationship among feeding arterial pressure, lesion size, and perfusion in cerebral cortex adjacent to cerebral arteriovenous malformations (AVMs).. Eleven patients with hemispheric AVMs underwent 99mTc hexamethyl-propyleneamine oxime single-photon emission CT before and after 1 g of acetazolamide was administered intravenously. AVM volume was estimated from MR dimensions and measured according to the method described by Pasqualin. Pressure measurements were obtained in arteries feeding the cortex adjacent to AVMs. Single-photon emission CT regions of interest were defined in cortex adjacent to the AVM and compared with contralateral regions using the Mountz method to estimate a baseline and dynamic (acetazolamide-challenged) perfusion defect volume.. Eight of 11 patients had baseline perfusion defects, but these defects were unrelated to feeding artery pressures (y = -.06x + 9.92, r2 = .04) or the dynamic change in defect volume after acetazolamide administration (y = .01x + .02, r2 = .002). However, there was a correlation between AVM volume and the baseline defect volume (y = .75x - 1.9, r2 = .76). Five patients had increased defect volume after acetazolamide administration; 5 patients had either no change in or improvement of perfusion. Dynamic changes in defect volume were related to feeding artery pressures.. Perilesional baseline perfusion defects appear to be related to lesion size and not to local arterial pressure. Cerebrovascular reserve generally was preserved, and perfusion defects appeared to be more pronounced with lower arterial pressures in feeding vessels. Although vasodilatory testing can unmask hemodynamic failure with severe local hypotension, baseline perfusion defects near the lesion and distant perfusion changes are more likely attributable to other causes such as mass-related or neurogenic changes.

Topics: Acetazolamide; Adaptation, Physiological; Adolescent; Adult; Blood Pressure; Carbonic Anhydrase Inhibitors; Cerebrovascular Circulation; Chronic Disease; Female; Homeostasis; Humans; Intracranial Arteriovenous Malformations; Male; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Vasodilation

Technetium Tc 99m-labeled hexamethylpropyleneamine-oxime (Tc-HMPAO) scintigraphy has been evaluated in adults with inflammatory bowel diseases and has shown promising ability to define intensity and extent of disease. To evaluate the method's utility in children, we studied 27 pediatric patients-23 with inflammatory bowel diseases and 4 control subjects without abdominal inflammation. Autologous leukocytes labeled with Tc-HMPAO were reinjected into each patient and serial scans were obtained up to 4 hours later. None of the control subjects had any uptake of Tc-HMPAO by the bowel. Disease localization as defined by the scan correlated well with that visualized in surgical specimens from five patients, at endoscopy in three patients, with barium studies of two patients, and with computed tomography scanning of the abdomen in one patient. A "scan score" was calculated by comparing uptake of tracer in five bowel segments with iliac crest bone marrow activity. Scan score correlated much better with clinical disease activity (correlation coefficient = 0.62) than did the erythrocyte sedimentation rate (correlation coefficient = 0.24). Scintigraphy with Tc-HMPAO appears to be useful in evaluation of disease localization and intensity in children with inflammatory bowel disease.

Topics: Adolescent; Child; Child, Preschool; Chronic Disease; Colitis, Ulcerative; Crohn Disease; Evaluation Studies as Topic; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Exametazime

In the management of major cerebral artery obstruction, cerebral perfusion reserve is key to introducing cerebral revascularization surgery. The purpose of this study was to evaluate the feasibility of assessing cerebral perfusion reserve by consecutive 99mTc-hexamethyl-propyleneamine oxime (99mTc-HMPAO) SPECT with 5% carbon dioxide (CO2) inhalation.. The CO2 inhalation and consecutive 99mTc-HMPAO SPECT study was performed on 30 chronic ischemic cerebrovascular disease patients with unilateral major cerebral artery obstruction and on 27 patients without. CO2 reactivity was expressed as the percent increase of 99mTc-HMPAO accumulation from the baseline (%Change) and as a constant k' that was the ratio of 99mTc-HMPAO accumulation per 1 mmHg change of end-tidal CO2 tension by exponential curve fitting.. The mean %Change and k' in the middle cerebral artery (MCA) territory on the side without an obstructive lesion or in the cerebellum ranged from 10.0% to 11.1% and from 0.98% to 1.13% per mmHg, respectively. In the MCA territory, an obstructive lesion was noted in 5.9% versus 0.54% per mmHg in the contralateral MCA territory (p < 0.01). Eleven of 30 patients with major cerebral artery obstruction revealed significant asymmetry in the k' value between bilateral MCA territories.. The results showed compromised cerebral perfusion reserve in the obstructed major cerebral artery territory. The present method was proven clinically useful for evaluating cerebral perfusion reserve in patients with unilateral major cerebral artery obstruction.

Topics: Adult; Aged; Arterial Occlusive Diseases; Blood Pressure; Carbon Dioxide; Cerebrovascular Circulation; Cerebrovascular Disorders; Chronic Disease; Female; Heart Rate; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The purposes of this study were: (1) to compare 99mTc-hexamethylpropyleneamineoxime (HMPAO) SPECT with CT and MRI in chronic traumatic brain injury (TBI) patients and (2) to correlate both functional and structural neuroimaging measurements of brain damage with neuropsychological (NP) performance.. Twenty-nine patients (minor TBI, n = 15 and major TBI, n = 14) and 17 normal controls (NC) underwent HMPAO SPECT, CT, MRI and NP testing. Imaging data were analyzed both visually and quantitatively.. Nineteen (66%) patients showed 42 abnormalities on SPECT images, whereas 13 (45%) and 10 (34%) patients showed 29 abnormalities on MRI and 24 abnormalities on CT. SPECT detected relatively more abnormalities than CT or MRI in the minor TBI subgroup. The TBI group showed impairment on 11 tests for memory, attention and executive function. Of these, the anterior-posterior ratio (APR) correlated with six tests, whereas the ventricle-to-brain ratio (VBR), a known structural index of a poor NP outcome, correlated with only two tests.. In evaluating chronic TBI patients, HMPAO SPECT, as a complement to CT or MRI, may play a useful role by demonstrating brain dysfunction in morphologically intact brain regions and providing objective evidence for some of the impaired NP performance.

Topics: Adult; Brain Injuries; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Double tracer autoradiography was performed to measure regional cerebral blood flow (rCBF) and the binding of central type benzodiazepine receptors (BZR) in infarction by means of permanent occlusion of the unilateral middle cerebral arteries (MCA) in rat. Iodine-125 Iomazenil and 99mTc-HMPAO was used to label BZR and rCBF respectively. In the chronic phase of infarction 21 to 28 days after occlusion (5 rats), rCBF in the left MCA territory was decreased to 62% of the sham control (4 rats), while BZR was more decreased to 45% of the control. In remote areas from the MCA lesion, the ipsilateral thalamus showed 28% decrease of BZR as compared to the control, though the decrease of rCBF was not significant. Iomazenil distribution may represent neuron density or BZR density on a neuron, since central type BZR is reported to be located on neurons. These results suggest that central type BZR imaging is more useful tool for the evaluation of brain tissue viability and transneuronal degeneration than rCBF imaging in brain infarction.

Topics: Animals; Autoradiography; Brain; Cerebral Infarction; Cerebrovascular Circulation; Chronic Disease; Flumazenil; Iodine Radioisotopes; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Rats; Rats, Inbred Strains; Receptors, GABA-A; Technetium Tc 99m Exametazime

The authors describe a patient with Rasmussen's syndrome detected by grossly abnormal results of Tc-99m HMPAO SPECT brain imaging obtained with a single-headed camera. Results of magnetic resonance imaging and cerebrospinal fluid examinations were normal.

Topics: Brain; Child, Preschool; Chronic Disease; Encephalitis; Epilepsies, Partial; Female; Hemiplegia; Humans; Organotechnetium Compounds; Oximes; Syndrome; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon

Thirty-five patients with suspected chronic osteomyelitis related to an orthopaedic device had 50 99Tcm-HMPAO-labelled leucocyte scans (LS). The scan appearances were compared with the bacteriological or clinical results and gave a sensitivity and specificity of HMPAO-LS of 83 and 100%, respectively. Bacteriological examination is often inaccurate in the diagnosis of osteomyelitis and therefore we assessed the clinical utility of HMPAO-LS. When the clinical, biological and radiological data were clearly suggestive of osteomyelitis (16/50) LS was unhelpful or even misleading when falsely negative (3/16). When the clinical, biological and radiological data were poorly suggestive of osteomyelitis (20/50) or conflicting (14/50) LS was misleading in only one patient (false negative). It is concluded that HMPAO-LS should only be performed to assist in the diagnosis of chronic osteomyelitis when there is no preexisting strong suspicion based on clinical, biological and radiological signs.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Chronic Disease; Female; France; Humans; Joint Prosthesis; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Orthopedic Equipment; Orthopedic Fixation Devices; Osteomyelitis; Oximes; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

The effects of the choice of the reference region in determining the relative regional cerebral blood flow (rCBF) using 99Tcm-hexamethylpropylene amine oxime (HMPAO) single photon emission tomography (SPECT) have been studied in order to establish or exclude it as a cause of inconsistencies in these studies. Relative rCBF was estimated by normalizing the regional count densities to two reference regions, the cerebellum and the whole slice, in 35 patients with Alzheimer's disease (AD), 25 patients with chronic schizophrenia (SCH) and the same number of matched normal volunteers. The statistical significance of the differences in rCBF between patients and their matched normals varied in the two sets of rCBF data. Smaller differences were highly significant while some larger differences were of less significance with whole slice normalization. The results suggest that the choice of reference region is one of the causes resulting in discrepancies in the results from various centres. The need to use a standard reference region is indicated.

Topics: Alzheimer Disease; Cerebrovascular Circulation; Chronic Disease; Female; Humans; Male; Organotechnetium Compounds; Oximes; Reference Values; Schizophrenia; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Regional cerebral blood flow (rCBF) during a word fluency task was compared in twenty-five male, right-handed, medicated schizophrenic patients and twenty-five age-matched male, right-handed healthy volunteers, using 99mtechnetium-HMPAO multidetector single-photon emission tomography. Increased rCBF in caudate and thalamus was found in patients, probably secondary to neuroleptic medication. Patients showed decreased rCBF in left frontal cortical regions and increased rCBF in left posterior cortical regions, compared to controls. Patterns of left-sided frontal rCBF dominance in controls were reversed in patients, as were normal patterns of right-sided parietal rCBF dominance. Negative symptom score correlated inversely with mesial frontal rCBF, particularly on the left.

Topics: Adult; Arousal; Attention; Brain; Brain Mapping; Chronic Disease; Dominance, Cerebral; Female; Frontal Lobe; Humans; Male; Middle Aged; Neuropsychological Tests; Organotechnetium Compounds; Oximes; Problem Solving; Psychiatric Status Rating Scales; Regional Blood Flow; Schizophrenia; Schizophrenic Language; Schizophrenic Psychology; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Regional cerebral blood flow was evaluated using Tc99m-HMPAO SPECT in 10 medicated patients with schizophrenia and 9 healthy volunteers. There were no prefrontal regions in the patient group with lower regional indices than in the control group. However, in the left hippocampal region, relative blood flow was significantly increased in the patient group compared with the control group. Furthermore, there was a relative increase in blood flow in the left basal ganglia of the patient group. A negative correlation coefficient was calculated between the relative blood flow in the left middle prefrontal cortex and the severity of the blunted affect, as well as between the relative blood flow in the left basal ganglia and the severity of the anhedonia-asociality. These findings indicate that prefrontal hypoactivity is not invariably present in all schizophrenics and that left basal ganglial hyperactivity may be associated with the effects of antipsychotic treatment and clinical improvement. Moreover, the left hippocampal hyperactivity may correspond to left limbic dysfunction in schizophrenia.

Topics: Adult; Brain; Brain Mapping; Cerebral Cortex; Chronic Disease; Hippocampus; Humans; Male; Organotechnetium Compounds; Oximes; Psychiatric Status Rating Scales; Regional Blood Flow; Schizophrenia; Schizophrenic Psychology; Social Isolation; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

We report the relationship between cerebral blood flow (CBF) and neuropsychologic tests in a patient with a chronic subdural hematoma suffering from severe dementia and left hemiparesis. Regional CBF was quantified using 99mTc-HMPAO SPECT and 133Xe-CBF. CBF-SPECT could detect the hematoma which was isodense by CT scan and the neuropsychological test improved remarkably with the increase in CBF after surgery. We conclude that if there is a strong clinical suspicion of subdural hematoma and CT scan is not diagnostic then CBF-SPECT may be valuable in localizing the hematoma and monitoring the effect of operation.

Topics: Aged; Cerebrovascular Circulation; Chronic Disease; Hematoma, Subdural; Humans; Male; Neuropsychological Tests; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

To assess the sequential changes seen in cerebral blood flow using Single Photon Emission Computed Tomography with 99mtechnetium-hexamethylpropylene amine oxime (99mTc-HMPAO SPECT) in acute ischaemic stroke, 35 patients were prospectively studied from June 1990- to March 1991. Scans were performed during the acute phase (1-7 days), sub-acute phase (8-21 days) and chronic phase of stroke (greater than 1 month). Nine patients underwent scans in all 3 phases, 15 patients had 2 scans, and 11 patients had one scan. The majority of infarcts were in the middle cerebral territory (15 patients), while 4 infarcts were in the posterior cerebral territory and two in the anterior cerebral territory. There was a total of 4 lacunar infarcts. Image analysis was by visual inspection and by semiquantitation using homologous regions of interest in opposite hemispheres. SPECT in the acute phase identified the final vascular territory affected in 19 of 27 patients. There were 8 patients in whom early SPECT predicted the vascular territory as seen on late CT scan when the early CT scan was normal. Hyperaemia or reperfusion in the involved vascular territory was identified in 10 patients on scans performed during the sub-acute phase. Late SPECT scans showed perfusion defects greater than the infarct size seen on CT scan in the majority of patients. In all cases, the perfusion defect on the late SPECT scan was equal to or larger than the defect seen on the acute or sub-acute scan. Crossed cerebellar diaschisis was identified in 8 patients, and cortical/subcortical diaschisis in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Brain Ischemia; Chronic Disease; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Technetium-99m-HMPAO labeled leukocytes demonstrated chronic femoro-femoral prosthetic vascular graft infection several times during an 18-mo period in a 77-yr-old man. The intensity and distribution of the uptake in the graft were fluctuating in different imaging occasions possibly indicating the strength and location of the infection. Gallium-67-citrate imaging showed negative results twice. The reason for negative 67Ga results remained obscure. The infected graft was removed and the patient did well 5 mo postoperatively.

Topics: Aged; Bacterial Infections; Blood Vessel Prosthesis; Chronic Disease; Enterobacteriaceae Infections; Humans; Leukocytes; Male; Organotechnetium Compounds; Oximes; Peptostreptococcus; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Adolescent; Adult; Aged; Chronic Disease; Diphosphonates; Female; Gallium Radioisotopes; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Predictive Value of Tests; Radionuclide Imaging; Technetium Tc 99m Exametazime

The case of a 69-year-old woman with chronic paroxysmal hemicrania (CPH) is presented in whom cerebral perfusion was investigated using the flow tracer 99mTc-hexamethyl propylenamino oxime (HMPAO) and single photon emission tomography (SPECT). There was a bilateral hypoperfusion in the fronto-parietal region between attacks--without medication as well as under effective treatment with verapamil. During an attack, however, SPECT investigation showed a normal cerebral perfusion. Further investigation is required to find out whether these SPECT findings are due to primary alterations of brain perfusion in CPH or are only of epiphenomenological nature. The observed effectiveness of verapamil in the prophylactic treatment of CPH should be verified in a greater number of patients.

Topics: Aged; Chronic Disease; Female; Humans; Middle Aged; Migraine Disorders; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Cerebral blood flow was measured in relative terms with Tc99m-hexamethylpropyleneamineoxim (HMPAO) and single photon emission computed tomography (SPECT) in 28 female schizophrenic patients (20 acute and 8 chronic) classified according to DSM-III. Eleven normals served as controls. The acute patients were classified according to positive and negative symptoms. Patients with predominantly positive symptoms showed by and large normal and homogeneous cerebral isotope uptake. Those with negative symptoms, and the chronic patients, showed inhomogeneous tracer uptake with multiple regions of hypoperfusion in slices 4-6 cm above the orbitomeatal line. The findings support in principle the notion that schizophrenia with negative or chronic symptoms does not affect the whole brain homogeneously. Brain imaging with Tc99m-HMPAO and SPECT might be used to distinguish various types of schizophrenia.

Topics: Adult; Brain; Chronic Disease; Female; Humans; Middle Aged; Organotechnetium Compounds; Oximes; Psychiatric Status Rating Scales; Regional Blood Flow; Schizophrenia; Schizophrenic Psychology; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon